Does Concomitant Meniscectomy or Meniscus Repair Affect Muscle Strength, Lower Extremity Balance, and Functional Tests after Anterior Cruciate Ligament Reconstruction?

Background/Objective: The effects of concomitant meniscal tears and their associated treatment on strength, lower extremity balance, and functional status after anterior cruciate ligament reconstruction (ACLR) have not been widely investigated. This study aimed to compare the functional outcomes in patients who underwent ACLR with concomitant treatment of the medial meniscus repair versus meniscectomy when returning to unrestricted physical activity. Methods: A total of 85 patients who underwent primary ACLR with combined meniscal repair (MREP; n = 39) or meniscectomy (MRES; n = 46) were assessed. The dataset included the Functional Movement ScreenTM (FMS) outcomes and single-leg balance test (SLBT) with anterior-posterior, medial-lateral, and overall stability indexes. Isokinetic knee extension and flexion strengths were tested at velocities of 60 deg·s-1 and 180 deg·s-1. The peak torque-to-body weight ratio (PT/BW) and limb symmetry index (LSI) were calculated. Results: In the functional assessment, there was no significant inter-group difference in the composite score of the FMS (MREP: 15.08 pts vs. MRES: 15.13 pts; p > 0.05). The SLBT outcomes in inter-group and inter-extremity comparisons were irrelevant (p > 0.05), too. Significant differences emerged in the inter-group comparison of the knee extension strength in the non-operated extremity at both 60 deg·s-1 and 180 deg·s-1 (p = 0.02). Inter-extremity differences were significant in both the MREP and MRES groups for knee extension and flexion at both angular velocities (all p values < 0.05). For knee extension, the LSI values ranged from 82% to 87%, and for flexion, from 77% to 84%, with no significant inter-group differences. Conclusions: Patients undergoing ACLR with concomitant meniscal repair or resection did not exhibit differences in isokinetic muscle strength, lower extremity balance, and functional tests upon returning to activity. However, participants in both groups demonstrated significant differences between the operated and non-operated extremities as far as the knee joint extensor and flexor strengths are concerned. Therefore, rehabilitation protocols should prioritize equalizing inter-extremity strength differences after the ACLR with additional treatment procedures addressing the menisci.

The Use of Physiotherapy in the Conservative Treatment of Cubital Tunnel Syndrome: A Critical Review of the Literature.

BACKGROUND: The lack of a clear answer regarding the efficacy of physiotherapy in the treatment of cubital tunnel syndrome (CuTS) has led to attempts to critically assess the scientific studies conducted to date. MATERIALS AND METHODS: Two databases (MEDLINE via PubMed and PEDro) and Google Scholar were used to search for papers. The inclusion criteria were randomized controlled trials, case series, and case reports that evaluate the effects of physiotherapy in the treatment of patients with CuTS. RESULTS: A total of 18 studies met the eligibility criteria, capturing a total of 425 participants. Seven papers were randomized controlled trials, three more described prospective studies without a control group, and eight papers contained case reports. An analysis of the literature evaluating the effectiveness of various forms of broadly defined physiotherapy indicates that their use can have a beneficial effect in reducing many subjective and objective symptoms and improving function. In the majority of papers included in this review, their authors indicated positive therapeutic effects. Only one randomized controlled trial reported no change following therapy. It can therefore be stated that the results of the research conducted so far are optimistic. However, only 7 of the 18 papers were randomized controlled trials, while 3 were prospective studies, and 8 papers were case studies, in which 23 people with CuTS were studied. CONCLUSIONS: The small number of randomized clinical trials and their considerable heterogeneity do not allow firm conclusions to be drawn about the effectiveness of physiotherapy in the conservative treatment of CuTS.

Assessment of Lateral Abdominal Muscle Activation Asymmetry via M-mode Ultrasonography.

INTRODUCTION: This study aimed to evaluate the asymmetry in the lateral abdominal muscles (LAMs) expressed as tissue deformation index asymmetry (aTDI) with the use of M-mode ultrasonography. The muscles of interest were the transversus abdominis, internal oblique, and external oblique. METHODS: This is a cohort of 126 healthy subjects who participated in the study. Measurements were taken by two raters, blinded to the aim of the study. M-mode ultrasounds with a measurement frequency of 5 MHz were utilized to record the postural response of LAMs to external perturbation in the form of rapid arm abduction with load, and individual aTDI values for each muscle were calculated. RESULTS: The aTDI values from deep to superficial LAMs were 78.28% for transversus abdominis, 55.68% for internal oblique, and 44.80% for external oblique. Only the aTDI for transversus abdominis results differed significantly from those of the other LAMs (P<0.05). CONCLUSION: LAM asymmetry values exhibit the following gradient: transversus abdominis >internal oblique >external oblique. Specifically, only transversus abdominis demonstrates noteworthy asymmetry in postural activity. This observation contributes to the literature by indicating that transversus abdominis asymmetry may serve as a marker for assessing the variability in motor control of the deep abdominal musculature. The dominance of transversus abdominis (TrA) asymmetric activity underlines the importance of personalized approaches for patients with lumbopelvic disorders or for athletes seeking to enhance performance.

Reliability of inter-recti distance measurement on ultrasound images captured by novice examiners.

BACKGROUND: With the increased interest in inter-recti distance measurement using ultrasound imaging in physiotherapy, there is a question of measurement reliability, and the importance of the examiner's experience. PURPOSE: The study aimed to investigate the reliability of inter-recti distance measurement in a DICOM viewer software by an experienced radiologist. For the measurement, the radiologist used linea alba images captured by two physiotherapists who were novice examiners. METHODS: Ultrasound images were acquired by two novice examiners on repeated occasions 7 days apart (sessions A and B) in 28 nulliparous women at supraumbilical, umbilical, and infraumbilical locations along linea alba. RESULTS: Excellent intra-examiner reliability of inter-recti distance measurements was shown at the supraumbilical and umbilical levels (ICC2,k = 0.941-0.983) with minimal detectable change (MDC95) ranging from 1.31 mm to 2.29 mm. Infraumbilical measurements had good to excellent reliability (ICC2,k = 0.894-0.972) with MDC95 ranging from 0.33 mm to 0.72 mm. Session A inter-examiner reliability was excellent for the mean measurements of two, three, four, and five images taken at each location (ICC2,k = 0.913-0.954) with MDC95 ranging from 0.47 mm to 2.96 mm. Session B inter-examiner reliability was excellent for the mean measurements of two, three, four, and five images taken at the supraumbilical and umbilical (ICC2,k = 0.94-0.98), MDC95 ranging from 1.38 mm to 2.58 mm and good (ICC2,k ≥ 0.81) with MDC95 ranging from 0.72 mm to 0.80 mm at the infraumbilical locations. CONCLUSION: Novice examiners were able to capture good-quality ultrasound images of the linea alba that allowed for good to excellent intra- and inter-examiner reliability.

Myofascial and Movement Tests after Anterior Cruciate Ligament Reconstruction.

Functional evaluation after anterior cruciate ligament reconstruction is one of the key points involved in decision making about the return of patients to full and unrestricted physical activity. The objective of the present study was to verify whether myofascial chain NEURAC® and Functional Movement Screen (FMS™) tests can be used to detect functional differences between the operated and the non-operated extremity in patients after anterior cruciate ligament reconstruction. A total of 83 young and physically active recreational athletes (mean age: 26.9 ± 9.7 years) who underwent primary single-bundle anterior cruciate ligament reconstruction using an autogenous semitendinosus-gracilis tendon graft were evaluated between the 3rd and the 4th month after surgery. Subjects received a similar, standardised rehabilitation programme. Two experienced raters, blinded to the objective of this study, were involved in functional outcome data collection using myofascial NEURAC® and Functional Movement Screen tests. Only two of the NEURAC® tests showed significant differences in the results between the operated and the non-operated extremity: the supine bridging (mean 2.92 vs. 3.51 points, p < 0.001) and prone bridging (mean 2.76 vs. 3.67 points, p < 0.001) tests. Additionally, the summary score of all NEURAC® tests significantly differed between extremities (mean 12.08 for the operated vs. 13.67 points for the non-operated extremity, p < 0.001). Myofascial tests (supine and prone bridging) in comparison with a battery of Functional Movement Screen tests seem to be more effective in detecting functional differences between the operated and the non-operated extremity at the early stage of recovery after anterior cruciate ligament reconstruction.

Experimentally induced low back pain influences brain networks activity.

Purpose of this study was to answer the question whether the recognized patterns of brain activity are likely to change under the influence of experimentally induced low back pain (LBP), and also to determine the functional networks of the brain engaged in this process. Twenty healthy subjects (8 women) participated. An experimental design was applied with repeated measurements of the blood oxygen level-dependent (BOLD) signal from the brain during two different voluntary contractions of the abdominal muscles without and with experimentally induced LBP. Brain areas showing significant differences in activity were identified and ascribed to the three functional neuronal brain networks: default mode network (DMN), pain matrix (PM), and sensorimotor (SM) areas. After implementation of the experimental painful stimulus the overall level of brain activity appears to be higher. No higher brain deactivations are seen in painful conditions and no higher activations in pain-free conditions. During isolated-type of muscular contraction a slight tendency to DMN deactivation may be observed.

A prospective longitudinal comparison of the sacral inclination angle in women between their early and advanced pregnancy and 6-month postpartum follow-up.

PURPOSE: The impact of pregnancy on the anterior-posterior sacral orientation and its relation to lumbopelvic pain and weight gain has not been fully recognized. This longitudinal study aimed to compare the sacral inclination angle in women between their early and advanced pregnancy and at 6 months postpartum. The authors also searched for a correlation between the sacral inclination and lumbopelvic pain, BMI and change in body mass. METHODS: Thirteen healthy women participated in the study. Data were collected at 8-16 and 35-38 weeks of gestation, and at 27-31.5 postpartum weeks. At each session, the women's sacral inclination angles were measured using the Saunders digital inclinometer. Data were also collected on lumbopelvic pain, BMI and body mass gain/loss. RESULTS: There was no effect of the evaluation period on the sacral inclination (p > 0.05); however, various individual values of the sacral inclination in pregnancy and postpartum were noted. In advanced pregnancy, 61.5% of the women had recurrent pain in the lumbopelvic region. The sacral inclination did not correlate with the lumbopelvic pain, BMI and body mass change (p > 0.05) in the pregnancy and postpartum periods. CONCLUSIONS: Advanced pregnancy did not influence sacral inclination. However, individuals varied in their responses. Therefore, we suggest that an individually-based physical therapy approach concerning proper posture during and after pregnancy should be emphasized. The sacral inclination had no impact on the occurrence of recurrent lumbopelvic pain. BMI and changes in body mass did not influence the sacral inclination in advanced pregnancy and at 6 months postpartum.

Deformations of abdominal muscles under experimentally induced low back pain.

PURPOSE: Low back pain (LBP) is associated with altered motor control and muscle activity; however, it remains unknown whether these changes predispose humans to injury and pain or are the consequence of ongoing nociceptive processes. In this experimental study, we aimed to use a novel ultrasound imaging technique for the measurement of lateral abdominal wall muscle activity: the tissue deformation index (TDI). METHODS: Forty-two healthy subjects (22.30 ± 1.49 years of age) were exposed to postural perturbation induced by rapid arm movement. Activity of three muscles, the transversus abdominis (TrA) and the internal and external oblique (EO), was recorded by ultrasound imaging (M-mode) with and without induction of LBP. Pain was induced by electrical stimulation applied bilaterally to the lumbar spine. RESULTS: No significant differences in the TDI between right and left sides of the body (p > 0.05) were found. Generally, muscles deformed slower with pain compared to non-painful conditions; however, only EO muscle displayed a statistically significant reduction in deformation velocity (p ≤ 0.00001). TDI for EO decreased from 0.065% per ms ( ± 0.038, 95% CI 0.057-0.074) to 0.053% per ms ( ± 0.035, 95% CI 0.046-0.061). Furthermore, characteristic inter-muscular TDI gradients were observed, directed from inner towards outer muscular layers, with TrA showing the lowest TDI and EO the highest. CONCLUSION: Experimentally induced LBP suppresses deformation of the superficial abdominal muscles and increases the variability of local/deep muscles. Further research is required to confirm these observations. These slides can be retrieved under Electronic Supplementary Material.

Passive stiffness of the hamstrings and the rectus femoris in persons after an ACL reconstruction.

OBJECTIVES: The aim of the article is to investigate the passive stiffness (PS) of rectus femoris and hamstring muscles working for the knee joint in persons after anterior cruciate ligament (ACL) reconstruction surgery. METHODS: Thirty subjects (8 women and 22 men) aged 19-46 (x = 28.2 ± 7) participated in the investigation; an experimental group comprised 15 persons (4 women and 11 men) who underwent ACL reconstruction surgery. The other persons had no knee injury and described themselves as healthy. All the subjects underwent an investigation of the PS of the hamstrings and the rectus femoris on the injured as well as on the healthy leg. RESULTS: The data shows vital difference in the PS of the hamstring muscles between the healthy and injured limb (p < 0.05), a significant difference in the PS of the rectus femoris (p < 0.001) was noted. Furthermore, the PS level of the hamstring muscles of the operated limb in the experimental group is significantly different to the both legs in control group (p < 0.001). CONCLUSIONS: Injury of the ACL results in a considerable increase in passive stiffness of the hamstring and rectus femoris muscles in both the injured leg and the healthy leg.

Asymmetry of activation of lateral abdominal muscles during the neurodevelopmental traction technique.

OBJECTIVE: The aim of the study was to evaluate the symmetry and pattern of activation of lateral abdominal muscles (LAM) in response to neurodevelopmental traction technique. DESIGN AND PARTICIPANTS: Measurements of LAM thickness were performed in four experimental conditions: during traction with the force of 5% body weight (5% traction): 1) in neutral position, 2) in 20° posterior trunk inclination; during traction with the force of 15% body weight (15% traction): 3) in neutral position, 4) in 20° posterior trunk inclination. Thirty-seven healthy children participated in the study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: To evaluate LAM activation level ultrasound technology was employed (two Mindray DP660 devices (Mindray, Shenzhen, China) with 75L38EA linear probes). An experiment with repeated measurements of the dependent variables was conducted. RESULTS: Side-to-side LAM activation asymmetry showed relatively high magnitude, however, significant difference was found only in case of the obliquus externus (OE) during stronger traction (P < 0.05). The magnitude of LAM thickness change formed a gradient, with the most profound transversus abdominis (TrA) showing the smallest change, and the most superficial OE - the greatest. The inter-muscle differences were most pronounced between the OE and TrA (P < 0.001). CONCLUSIONS: During the neurodevelopmental traction technique there is a difference in individual LAM activation level, with deeper muscles showing less intense activation. In statistical terms, the only signs of side-to-side asymmetry of LAM activation are visible in case of the OE, however, the magnitude of asymmetry is relatively high. The results allow to identify patterns of activation of LAM in children showing typical development that will serve as a reference in future studies in children with neurological disorder.

The impact of core muscles training on the range of anterior pelvic tilt in subjects with increased stiffness of the hamstrings.

The aim of this study is to verify the hypotheses that muscular coordination training of the core region in subjects showing increased hamstring stiffness results in an increase in anterior pelvic tilt and that there is a correlation between hamstring stiffness and anterior pelvic tilt. The two-group, non-blinded experimental controlled trial with three repeated measurements of the dependent variables. The experimental group received muscular coordination training during a period of two weeks, control group - no training. Thirty generally healthy subjects (9 women) were randomly assigned to the two equal groups. Passive knee extension test (hamstring stiffness); the range of anterior pelvic tilt (as measured in neutral standing position and during forward bending of the trunk). A significant decrease in the level of hamstring stiffness was recorded in the experimental group accompanied by an increase in anterior pelvic tilt. No significant changes were observed in the control group. There was a significant, negative, and moderate correlation between hamstring stiffness and anterior pelvic tilt with forward bending of the trunk).

The impact of the neurodevelopmental traction technique on activation of lateral abdominal muscles in children aged 11-13 years.

BACKGROUND: The aim of the study was to evaluate the activation of lateral abdominal muscles (LAM) in response to neurodevelopmental traction technique as assessed by ultrasounds as well as to compare the effects of different traction forces. OBJECTIVE: An experiment with repeated measurements of the dependent variables was conducted. Thirty-seven children (22 girls) participated. METHODS: Measurements of LAM thickness (indicating LAM activation) were performed bilaterally during traction of 5% body weight: 1) in neutral position, 2) in 20° posterior trunk inclination; during traction of 15% body weight: 3) in neutral position, 4) in 20° posterior trunk inclination. The ultrasound technology was employed. RESULTS: When applying the lighter traction the superficial LAM (external and internal oblique muscles) showed significant changes. The mean thickness of both muscles during traction increased (both p < 0.001). The deepest transversus abdominis showed no response (p > 0.05). Stronger traction elicited smaller changes. External and internal oblique muscles showed significant increases (p < 0.001, p < 0.01, respectively). Transversus abdominis became less thick during stronger traction (p < 0.01). CONCUSIONS: The neurodevelopmental traction technique elicits the changes in LAM thickness in children with typical development. The superficial LAM show more distinct responses than the profound LAM. Stronger traction induces smaller LAM thickness changes than lighter traction.

Influence of passive stiffness of hamstrings on postural stability.

The aim of the study was to explore whether passive stiffness of the hamstrings influences the strategy of maintaining postural stability. A sample of 50 subjects was selected; the final analyses were based on data of 41 individuals (33 men, 8 women) aged 21 to 29 (mean = 23.3, SD = 1.1) years. A quasi- experimental ex post facto design with repeated measures was used. Categories of independent variables were obtained directly prior to the measurement of the dependent variables. In stage one of the study, passive knee extension was measured in the supine position to assess hamstring stiffness. In stage two, the magnitude of postural sway in antero-posterior direction was measured, while varying the body position on a stabilometric platform, both with and without visual control. The margin of safety was used as a measure of postural control. The magnitude of the margin of safety increased significantly between the open-eye and closed-eye trials. However, although we registered a visible tendency for a larger increase of the margin of safety associated with lower levels of passive hamstrings stiffness, no significant differences were found. Therefore, this study demonstrated that hamstring stiffness did not influence the strategy used to maintain postural stability.

Kinesiophobia - introducing a new diagnostic tool.

Technical development of human civilisation brings about a decrease of adaptation potential of an individual, which is directly linked to deficient motor activity. Only precise identification of factors leading to hypokinesia would make prophylactic and therapeutic actions possible. In this article, authors would like to introduce a new, original tool aiming at diagnosing limitations of motor activity in adults. They propose a synthetic diagnosis of hypokinesia in two domains: biological and psycho-social, which is based on the contemporary model of health.

Reliability of the passive knee flexion and extension tests in healthy subjects.

OBJECTIVE: Information on the reliability of the passive knee extension (PKE) and passive knee flexion (PKF) tests is still incomplete. Moreover, standardization of the 2 test procedures could be enhanced. The present study investigates interrater and test-retest reliability of the modified versions of the PKE and PKF tests to establish whether the level of reliability is sufficiently high to justify their use in scientific studies and clinical practice. METHODS: A total of 14 healthy subjects met the selection criteria. The 2 tests were carried out successively by each of the 3 clinicians/raters involved in the study, and each test was repeated 3 times. Two series of such measurements were performed. To evaluate interrater and test-retest reliability of the 2 tests, we calculated the intraclass correlation coefficients (ICCs), the standard errors of measurement, and the smallest detectable differences. RESULTS: The PKE and PKF tests showed excellent and good reliability, respectively. Mean ICCs for the PKE were greater than those for the PKF. Mean ICCs for the interrater reliability (0.88-0.93) were higher than those for test-retest reliability (0.84-0.93). No mean ICCs lower than 0.84 were found (test-retest for PKF). The lowest ICCs of 0.73 and 0.75 were registered for the test-retest reliability of PKF in the case of rater 1. CONCLUSION: These results show excellent and good interrater and test-retest reliability of the PKE and PKF, respectively. The PKE test seems to be slightly more reliable. These findings may help clinicians when using these tests. For research purposes, investigators must critically evaluate whether the presented amount of error is acceptable for a specific setting.

Butler's neuromobilizations combined with proprioceptive neuromuscular facilitation are effective in reducing of upper limb sensory in late-stage stroke subjects: a three-group randomized trial.

QUESTION: Are Butler's neuromobilizations combined with proprioceptive neuromuscular facilitation and traditional post-stroke therapy more effective in reducing affected upper extremity sensory deficits in late-stage stroke subjects than proprioceptive neuromuscular facilitation combined with traditional therapy or traditional therapy alone? DESIGN: Pretest-posttest three-group randomized clinical experimental design. PARTICIPANTS: A total of 96 late-stage stroke subjects were randomly assigned to three groups. INTERVENTION: The therapeutic programme in the control group was based on traditional post-stroke methods. The second group (experimental 1) received in addition individual therapy based on the proprioceptive neuromuscular facilitation method. The third group (experimental 2) received a combination: traditional therapeutic programme plus individual proprioceptive neuromuscular facilitation exercises plus neuromobilization of the affected upper extremity. All groups received 18 training sessions lasting about 45 minutes each. OUTCOME MEASURES: Assessment of the two-point discriminatory sense (distance between the tips of the compass when the subject indicated two-point sensation), stereognosia (identification up to 10 objects by touch) and thermaesthesia (using hot and cold cylinders on dermatomes C6-C8) were performed. RESULTS: Analysis of change scores showed that two-point discriminatory sense for experimental group 2 was significantly better than that in the two other groups (P<0.001). Similar results were registered for thermaesthesia (experimental 2 versus experimental 1 P<0.01; experimental 2 versus control P<0.001). For stereognosia the only significant difference was found between experimental group 2 and the control group (P<0.05). CONCLUSION: In our subjects, application of Butler's neuromobilizations combined with proprioceptive neuromuscular facilitation showed greater effectiveness in reducing sensory deficits than proprioceptive neuromuscular facilitation or traditional therapy alone.

Induced static asymmetry of the pelvis is associated with functional asymmetry of the lumbo-pelvo-hip complex.

OBJECTIVE: This study evaluates the hypothesis that triggering and eliminating induced static pelvic asymmetry (SPA) may be followed by immediate change in functional asymmetry of the lumbo-pelvo-hip complex. METHODS: Repeated measures experimental design with 2 levels of independent variable, that is, induced SPA triggered and induced SPA eliminated, was implemented. Three series of measurements were performed, that is, baseline, after triggering SPA, and after eliminating SPA. A group of 84 subjects with no initial symptoms of SPA was studied. Different forms of mechanical stimulation were applied aiming to induce SPA, and the 2 manual stretching-manipulating techniques were performed aiming to eliminate it. A hand inclinometer was used to measure SPA in standing posture. Selected ranges of motion of the hip joints and lumbar spine were used to depict functional asymmetry of the lumbo-pelvo-hip complex. The functional asymmetry indices for individual movements were calculated. Repeated measures design of analysis of variance, dependent data Student t test, and linear Pearson's correlation test were used. RESULTS: Assessment of the SPA showed its significant increase between baseline and series 2 measurements, with a subsequent significant decrease between series 2 and series 3 measurements. Values of the functional asymmetry indices changed accordingly, that is, they increased significantly between series 1 and series 2 and had returned to their initial level in series 3 measurements. CONCLUSIONS: Induced SPA shows considerable association with functional asymmetry of the lumbo-pelvo-hip complex.

Ground-foot reaction forces in hemiplegic gait patterns with and without orthopaedic aids.

The objective of this study was to attempt the analysis of the ground-foot reaction forces in hemiplegic patients in routine gait re-education conditions, with and without supporting this process with typical orthopaedic aids. Ninety people with hemiparesis participated. The subjects were divided into three groups, according to their locomotion type (no walking aids, stick and elbow crutch). The ground-foot reaction forces during level gait trial were measured for each subject. Analysis was carried out by means of Kistler lane. The ANOVA results showed a considerable effect on almost all ground-foot reaction force parameters, brought about both by the paralysis itself and any walking stick or elbow crutch supporting locomotion. The use of the orthopaedic provisions, especially the elbow crutch, prolongs the time of the single-stance phase duration considerably. In conclusion, the distinct asymmetry of hemiplegic gait manifests itself in the distribution of the ground-foot reaction force. In the sagittal plane, the values of the force impulse indicate that people with a walking stick accelerated using the healthy limb and slowed down using the paralysed limb. In elbow crutch patients the acceleration function seems to be taken over by the crutch.